Dr. Adrian Morris of Surrey Allergy Clinic Tests and Treats allergies » Allergy Testing

Cow’s milk allergy may be misdiagnosed in babies

Dr. Adrian Morris — Mon, 06 Dec 2010 08:15:37 +0000

Cow’s milk allergy is relatively common in babies (1:50) but rarely develops after one year of age. Symptom improvement on a cow’s milk-free diet and recurrence of symptoms with reintroduction of cow’s milk formula is the most accurate diagnostic procedure. Cows milk allergy may be underdiagnosed as it is common (but misguided) practice amongst UK GP’s and Paediatricians only to perform food allergy testing in children once they are 4 years or older.

Skin prick tests using fresh cow’s milk and RAST blood tests for cow’s milk protein IgE antibodies are the only reliable tests and have 60-90% accuracy. The whey (liquid) fraction of milk tends to cause most allergies, but the casein (curd) fraction triggers more severe and persistent allergies.The higher the milk-specific IgE level, the more likely there will be a clinically relevant milk allergy. High levels of Casein specific IgE antibodies indicate a higher risk for severe cows milk allergy and also for persistent cows milk allergy, On the other hand, IgG antibody testing for cow’s milk proteins (casein and b-lactoglobulin) is of no allergy diagnostic value and merely indicates exposure.

The clinical history and observation of the infant feeding are very helpful, and a family history of atopy increases the likelihood of a food allergy. Cow’s milk allergy can manifest with immediate urticaria and facial angioedema and respiratory, oral and laryngeal symptoms, as well as deteriorating eczema in addition to typical intestinal symptoms such as vomiting, diarrhoea, persistent reflux, food refusal and even anaphylaxis in severe cases.

Mildly milk-allergic infants often tolerate small amounts of processed dairy produce such as yoghurt and cheese as well as Goat’s milk. Infants with severe cow’s milk allergy will react to any traces of milk protein in partially hydrolysed milk formula, cooked foods and even breast milk, as well as any skin contact with milk proteins.

High Street allergy tests mislead public

Dr. Adrian Morris — Mon, 22 Feb 2010 19:07:01 +0000

The Sunday Times newspaper has again produced a masterpiece of investigative journalism (Sunday 21st February 2010) highlighting the frightening number of nonsense allergy and food intolerance tests available in central London. It is amazing that there is no public watchdog to prevent these unvalidated and unscientific allergy tests from being promoted to unsuspecting members of the public by inadequately trained practitioners and nutritionalists. Well done to Gillian Passmore and the Sunday Times for again drawing attention to the issue of misleading unorthodox allergy testing.

http://www.timesonline.co.uk/tol/life_and_style/health/article7034867.ece

Irritable bowel syndrome (IBS)

Dr. Adrian Morris — Thu, 14 Jan 2010 17:32:25 +0000

Irritable bowel syndrome otherwise called IBS is a common medical condition affecting the lower bowel in 1 in 5 young adults. Females are especially prone to IBS which presents with one or more of 3 cardinal symptoms:

A. Abdominal pain and spasm which eases when emptying the bowels.

B. Bloating, fullness on eating and abdominal distension with wind.

C. Change in bowel habit with passage of frequent loose mucus-laden stools (an enhanced gastro colic reflex), often alternating with episodes of constipation.

Other more serious bowel conditions such as food allergies, inflammatory colitis, stomach ulcers, intestinal infection and coeliac disease may cause similar but more intense symptoms, and will need to be excluded by testing. A few simple blood tests undertaken by your GP (such as ESR, CRP, FBC) will exclude colitis or gut infection, while specific IgE allergy testing will identify food allergy and coeliac screening measuring Tissue Transglutaminase antibodies will exclude gluten intolerance. Certain non-specific food intolerances may be triggers for IBS and these include excess fruit intake, wheat, dairy produce, onions, excess tea, coffee, alcohol and highly insoluble dietary fibre such as bran, all of which may exacerbate IBS symptoms. The artificial sweetener Sorbitol and processed starch in ready meals may also promote IBS. While emotional stress, masked depression and missed or erratic meals may also be triggers, whereas taking a regular Probiotic supplement (Acidophilus GG) and drinking plenty of filtered water every day may calm the symptoms.

Discuss any concerns you might have regarding food allergies, intolerance or colitis with your GP, Practice Nurse or a qualified Dietician.

http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927

18% increase in food allergies amongst US children

Dr. Adrian Morris — Wed, 18 Nov 2009 07:36:13 +0000

A scientific study due to be published in the American medical journal Pediatics (December 2009) has found a massive 18% increase in reported food allergies amongst US children (under 18 yrs of age). This increased reporting of food allergies took place over the last decade between 1997 and 2007. While between 1993 and 2006 ambulatory visits to the doctor for food allergies have tripled. In 2007 alone, 3.9% of US children reported food allergic conditions. The most severely affected were ethnic minorities such as Hispanics. In 2005 to 2006, an estimated 9% of US children had detectable peanut IgE in their blood on allergy testing while over the same period hospitalisations with a diagnosis of food allergy also tripled. It is uncertain whether this trend is due to a true increase in food allergic diseases or represents increasing allergy testing and physician and parental food allergy awareness.

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1210v1

Home hygiene, infections and allergies

Dr. Adrian Morris — Thu, 12 Nov 2009 11:40:27 +0000

A recent study on children attending day care or nurseries by de Jongste in the American Thoracic Society journal cast some doubt on the so-called Hygiene Hypothesis for allergy development. The Hygiene Hypothesis notion that farm animal faeces exposure and childhood infections will prevent allergies has been promoted for decades. The hygiene hypothesis essentially links a more clean and sterile home environment with the overall rise in allergies seen in many developed Western counties. Poor living conditions with early exposure to germs, infections and parasites seem to shift the infant’s immune system into survival mode (TH1) and away from allergy mode (TH2) when allergy testing. However this immune switching probably occurs very early in the first few months of life. Therefore as mentioned in the American study, day care centre exposure and subsequent childhood infections may have little impact on allergy development. Particularly if the child attends a day-centre after one year of age when their immune type reactivity is more established. It still seems likely that a germ-filled household with difficult living conditions and plenty of sickly older siblings will be more protective from allergies while a sterile, insular environment in early infancy seems to promote allergies.

http://news.bbc.co.uk/2/hi/health/8241774.stm